Copeptin, a fragment of the vasopressin precursor, as a novel predictor of outcome in heart failure


  • Department of Infectious Diseases Medical University of Vienna, (B. Stoiser); Department of Cardiology Medical University of Vienna, Austria (D. Mörtl, M. Hülsmann, R. Berger, R. Pacher); B.R.A.H.M.S. AG Henningsdorf, Germany (J. Struck, N. Morgenthaler, A. Bergmann).

Martin Hülsmann, MD, Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18–20, A-1090 Vienna, Austria. Tel.: +431404004616; fax: +43 14081148; e-mail:


Background  Natriuretic peptides, particularly brain natriuretic peptide (BNP), are elevated in heart failure and therefore considered to be excellent predictors of outcome. Vasopressin is also known to be related to the severity of heart disease. Copeptin – an inactive fragment of the vasopressin precursor – has not been previously investigated in the context of heart failure.

Materials and methods  We prospectively studied 268 patients with advanced heart failure after they had been discharged from the hospital. We investigated the ability of BNP and copeptin to predict death, re-hospitalization due to heart failure, and a combination of the two endpoints.

Results  Over a mean follow-up period of 15·8 months (up to 24 months), 83 patients died, 122 patients experienced worsening of heart failure, and 145 patients achieved the combined endpoint. Univariate predictors of death were copeptin, BNP, age and impaired kidney function. In multivariate analysis, copeptin (χ2 = 16, P < 0·0001) and age (χ2 = 4, P < 0·05) were independent predictors. Univariate predictors of re-hospitalization due to heart failure were copeptin, BNP, age and impaired kidney function. Furthermore, in multivariate analysis BNP (χ2 = 18, P < 0·0001), age (χ2 = 11·8, P < 0·001) and copeptin (χ2 = 4·2, P < 0·05) were found to be independent predictors.

Conclusion  Our study is the first to show that copeptin is an excellent predictor of outcome in advanced heart failure patients. Its value is superior to that of BNP in predicting death and a combined endpoint, although BNP is still suitable for predicting chronic heart failure (CHF) re-hospitalization. Our data imply that vasopressin antagonism might be a new target to improve outcome in this population.